Volume 96  ·  Issue 17  ·  2016

Diabetes is one of the important diseases that threaten human health at present. It is estimated that by 2030, the number of diabetic patients in the world will reach 550 million. Diabetic nephropathy is the main cause of renal failure in diabetic patients. A retrospective analysis of hospitalized diabetic patients in China in 2001 showed that 33.6% of them were complicated by diabetic nephropathy; The epidemiological study of chronic kidney disease in China shows that the prevalence of chronic kidney disease in China is 10.8%, and 36.4% of this population have diabetes^[1]。 The main pathological features of diabetic nephropathy are glomerular hypertrophy, basement membrane thickening and extracellular matrix accumulation, which gradually progresses to glomerular sclerosis and tubulointerstitial fibrosis. The clinical manifestation is early microalbuminuria, and gradually progresses to massive albuminuria, which eventually leads to renal failure. At present, the known pathogenesis of diabetic nephropathy includes genetic susceptibility, epigenetic regulation, oxidative stress, inflammatory response, cytokine activation and renal hemodynamic changes, etc. However, its pathogenesis is extremely complex and has not been fully elucidated. Therefore, it is important to understand the mechanism of diabetic nephropathy in depth for the prevention and treatment of diabetic nephropathy.

Diabetic nephropathy (DKD) is a serious microvascular complication of diabetes, occurring in about 1/3 of diabetic patients. The continuous increase in the prevalence of diabetes, which directly leads to an increase in the incidence and mortality of diabetic nephropathy, brings great challenges to the healthcare system. Genetic susceptibility is an important factor in the occurrence and progression of diabetic nephropathy, and the research to determine its susceptibility genes is being carried out worldwide. The risk of diabetic nephropathy in diabetic patients can be increased several times under the combined action of risk alleles at different susceptibility sites [such as angiotensin converting enzyme (ACE) gene, apolipoprotein E (ApoE) gene, adiponectin gene (ADIPOQ), etc.]. Therefore, finding genetic variation as a biomarker to detect patients at high risk of diabetic nephropathy is helpful for their early diagnosis, treatment and prevention. Among individuals with diabetic nephropathy, the different combination of genetic variation constitutes the genetic heterogeneity of the disease, while the genetic heterogeneity between different races constitutes the ethnic heterogeneity. Recently, genome-wide association studies (GWAS) to explore disease susceptibility genes have identified several novel pathogenic gene loci in diabetic nephropathy, emphasizing that more in-depth genetic studies in different ethnic populations can reveal their genetic susceptibility. Epigenetics has the role and effect of regulating the genetic susceptibility of diabetic nephropathy.

Diabetic nephropathy (DKD) is the leading cause of chronic kidney disease (CKD) in developed countries and is also becoming the leading cause of CKD in developing countries. DKD is one of the chronic microvascular complications of diabetes and one of the leading causes of death in diabetic patients. Patients with type 2 diabetes may develop DKD after 10 to 20 years. However, the renal reserve function of the elderly is reduced, and the degree of renal failure is more serious than that of the younger people. Therefore, preventing and delaying the development of DKD can improve the survival rate of elderly diabetic patients.

To investigate the relationship between serum free fatty acid (FFA) level and glomerular filtration rate (GFR) in patients with type 2 diabetes mellitus (T2DM).

A total of 442 T2DM patients treated in Sir Run Run Shaw Hospital from January 2013 to June 2015 were retrospectively analyzed and divided into three groups according to estimated glomerular filtration rate (eGFR) levels using modified modification of diet in renal disease (MDRD) formula: eGFR≥90 ml·min^-1·1.73 m^-2group (group A, 227 cases), 60 ml·min^-1·1.73 m^-2≤eGFR<90 ml·min^-1·1.73 m^-2group (group B, 118 cases), and eGFR<60 ml·min^-1·1.73 m^-2group (group C, 97 cases). In addition, 50 body mass index (BMI)-matched non-diabetic subjects were selected as control group. Fasting serum FFA level was measured in each group, and its relationship with eGFR was analyzed.

FFA level in group C[(450±203)μmol/L]was significantly higher than that in group A[(326±167)μmol/L], group B[(394±184)μmol/L]and control group[(320±90)μmol/L](allP<0.05). Meanwhile, FFA level in group B was higher compared with that in group A (P<0.05). However, no statistical difference was found in FFA level between group A and Control group (P>0.05). Multiple linear regression analysis using eGFR as the dependent variable demonstrated that uric acid (UA), FFA, triglyceride (TG), total cholesterol (TC), albuminuria, hypertension, smoking and duration of diabetes were all independent risk factors for decreased eGFR (allP<0.05).

The present results suggest that increased FFA level might be involved in the development of diabetic nephropathy.

To study the effect of metanephric mesenchyme cells on podocytes apoptosis induced by high glucose.

Mice's podocyte was culturedin vitro,and apoptosis and injury model of podocyte was then established by high glucose (30 mmol/L) induction. Metanephric mesenchyme cells were extracted from E13.5 mouse embryos and used to make conditioned medium which was used to treat podocytes apoptosis. The flow cytometry and confocal fluorescence imaging were used to detect the apoptosis ratio and cytoskeletal protein (synaptopodin) expression of podocyte at several time points (24, 48, 72 h), in order to explore the effect of high glucose on podocytes and the treatment effect of metanephric mesenchyme cell conditioned medium.

Significant increasing of podocyte apoptosis ratio and decreasing in synaptopodin expression contrast to control group was observed after induction of high glucose, with a statistical difference. Metanephric mesenchyme cells could be isolated from E13.5 mouse embryos successfully, and had the capacity of osteogenic and adipogenic differentiation. Metanephric mesenchyme cell conditioned medium and high glucose stimulations was used to generate podocytes cells. Compared to the group treated with high glucose stimulation, the flow cytometry detection result suggested that metanephric mesenchyme cell could reduce podocytes apoptosis in a dose-dependent manner: with increasing in the concentration of metanephric mesenchyme cell conditioned medium, the treatment effect was better.

Metanephric mesenchyme cells could prevent apoptosis and injury of podocyte induced by high glucose.

To explore the renoprotective effects of (-)-epigallocatechin-3-gallate (EGCG) and its potential mechanism in type 2 diabetic db/db mice.

8-week-old db/db mice (6 h fasting plasma glucose >16.7 mmol/L) were allocated randomly into Control group (non-intervention group, n=8), EGCG A group (50 mg·kg^-1·d^-1,n=8), EGCG B group (100 mg·kg^-1·d^-1,n=8). Before the study and after the intervention (in the 4^thand 8^thweek), the body weight, the level of fasting plasma glucose, oral glucose tolerance test (OGTT) were measured and 24 h urine samples were collected. 24 h proteinuria was measured by routine chemical method. The levels of angiotensin Ⅱ(AngⅡ), fasting plasma insulin and urinary 8-OHdG were measured with enzyme-linked immunosorbent assay (ELISA). The protein expression levels of angiotensin Ⅱ type 1 receptor (AT-1R), nicotinamide adenine dinucleotide phosphate (NADPH) oxidase subunit P22-phox, NADPH oxidase subunit P47-phox, phospho-extracellular regulated protein kinases (p-Erk1/2), phospho-P38 mitogen-activated protein kinase (p-P38MAPK), phospho -phosphatidylinositol 3-hydroxy kinase (p-PI3K) and phospho-protein kinase B (p-AKT) were determined by Western blot. The renal pathological changes were examined by the method of PAS (periodic acid-Schiff stain).

After 8 weeks of treatment with EGCG, the level of fasting plasma glucose decreased[(14.4±1.0) mmol/L, (14.2±0.7) mmol/L vs. (17.2±0.8) mmol/L]; the level of fasting plasma insulin increased[(13.2±1.2)mU/L, (13.4±1.3) mU/L vs. (9.9±1.0) mU/L]; the area under the curve (AUC) of OGTT decreased[(49.3±1.8) mmol·L^-1·h^-1,(44.8±0.7) mmol·L^-1·h^-1vs. (60.0±0.8) mmol·L^-1·h^-1]; the level of 24 h proteinuria[(8.8±1.0) mg, (8.6±1.1) mg vs. (11.7±1.3) mg]and urinary 8-OHdG[(90±5) ng/d, (78±5) ng/d vs. (118±10) ng/d]decreased; the level of serum Ang-Ⅱ[(498±23) ng/L, (511±19) ng/L vs. (688±17) ng/L]and renal cortex AngⅡ[(367±5) ng/L, (384±10) ng/L vs. (406±7) ng/L]decreased; the expression levels of AT-1R, P22-phox, P47-phox, p-Erk1/2, p-P38MAPK downregulated obviously and the expression levels of p-PI3K, p-AKT increased significantly (P<0.05), and renal pathology improved as compared with the control group. After 8 weeks of treatment with EGCG, the level of urinary 8-OHdG decreased (P=0.007) and the AUC of OGTT also decreased (P=0.01) in EGCG B group when compared with the EGCG A group.

EGCG protects the kidney in diabetic db/db mice via anti-oxidative stress pathway, as well as inhibiting Erk1/2-P38MAPK pathway and improving PI3K-AKT signaling transduction pathway.

To investigate the clinical features of systemic malignancy patients with acute cerebral hemorrhage as well as its underlying mechanism.

The clinical data, including presentation, lab tests and neurological images, of systemic malignancy patients with acute cerebral hemorrhage at the First Affiliated Hospital of Guangxi Medical University between January 2003 and December 2014 were collected and analyzed.

Among 61 326 systemic malignancy patients, 25 patients(0.04%)were found with acute cerebral hemorrhage and were enrolled. Out of these 25 patients, age ranged from 31 to77 years old, with an average age of 61 years, 18 patients were males. The clinical features of the systemic malignancy patients with acute cerebral hemorrhage were found that most patients (14/25, 54.0%) lacked traditional risk factors, with sudden symptom onset and some degree of neurologic deficiency in all patients, and most hemorrhagic lesions (19/25, 76.0%) involved the hemicerebrum, for most patients (16/25, 60.0%) cerebral hemorrhage occurred after 3 days to 3 years of the malignancy diagnosis, and some malignancy patients (8/25, 32.0%) presented with cerebral hemorrhage as the first presentation. The common subtypes of malignancy found were lung cancer (8/25, 32.0%), liver cancer (7/25, 28.0%), and then gastric carcinoma (6/25, 24.0%). Most patients (22/25, 88.0%) had elevated plasma level of cancer biochemical marks (including one or more than one of cancer antigen 125, 153 and 199, carcino-embryonic antigen, and alpha fetal protein), most patients (16/25, 64.0%) were found to have coagulation disorder.

The unique clinical features of the systemic malignancy patients with acute cerebral hemorrhage are most patients lacking traditional risk factors, with coagulation disorder and with hemorrhagic lesions in hemicerebrum. And coagulation disorder might be responsible for the cerebral hemorrhage.

To investigate the safety of implantation permanent pacemaker (PM) at different times in patients with dual antiplatelet (DAPT) therapy after implantation of drug-eluting stent (DES).

A total of 105 patients who implanted pacemakers with DAPT therapy (clopidogrel and aspirin) after implantation of DES admitted to our hospital from January 2009 to January 2015 were enrolled in the study. The patients were divided into 3 groups: dual antiplatelet therapy (DAP) group: implanting PM within 3 months after coronary stenting, continuous DAPT during perioperative period; low molecular weight heparin (LMWH) bridging group: implanting PM within 3 to 6 months after coronary stenting, DAPT interruption for 5 days replaced with subcutaneous injection of enoxaparin (1 mg/kg), twice per day, enoxaparin was stopped 12 h before operation; asprin group, implanting PM after coronary stenting 6 months, clopidogrel interruption for 5 days. Oral DAPT was returned 12-24 after operation according to the patients' condition. Peri-operative cardiovascular events and bleedings, infections were observed.

There was no major adverse cardiac event (MACE) and pouch infection were observed among 3 groups in perioperation. The incidence of pocket hemorrhage and errhysis in bridging group was significantly higher than that of DAP group and asprin group (16.7%, 8.0%, 0.0% χ ²=10.431, P=0.005 and 29.2%, 12.0%, 7.1% χ ²=6.321, P=0.042 respectively). 3 patients had severe bleeding (12.5%, 3/24) in bridging group; compared with the other 2 groups, there were significant difference (χ²=9.161, P=0.010). The incidence of hematoma and hemorrhage of asprin group was lowest.

LMWH bridging therapy significantly increases the risk of pacemaker pocket hematoma and hemorrhage, and the pacemaker implantation may be safer after DES implantation 6 months.

To analyze the effect of preoperative factors on the clinical outcome in patients receiving total knee replacement.

From January 2011 to September 2013, 145 patients (206 knees; 22 males, 31 knees; 123 females, 175 knees)receiving total knee arthroplastywere successfully included in this study and followed up. The average ages was (66.5±7.6) years old(range, 51-83 years old). The data of preoperative factorsincludedgender, age, body mass index (BMI), preoperative range of motion (ROM), the knee varus angle, flexion deformity and preoperative the hospital for special surgery (HSS) scorewere collected. The correlation between preoperative factors and the clinical outcome (postoperative HSS score, postoperative ROM)after total knee replacement was evaluated statistically.

The average follow-up time was 35 months (range, 24-56 months). The HSS score was increased from (55.1±7.6) preoperativelyto (89.3±5.1) postoperatively. ROM elevated from (95.6±10.0)°preoperatively to (115.1±7.8)° postoperatively.The correlation analysis showed that the postoperative ROM was positively correlated with the preoperative ROM, and was negatively correlated with the BMI, the knee varus angle(r=-0.864, -0.353, all P<0.01). The postoperative HSS score was positively correlated with preoperative ROM, preoperative HSS score(r=0.101, 0.244, P=0.033, P<0.01), and was negatively correlated with the BMI (r=-0.277, P=0.039).

Total knee arthroplasty can definitely improve the function of knee joint. The BMI, the preoperative ROM, the knee varus angle and preoperative HSS score have influence on postoperative function of patients receiving total knee arthroplasty.

To evaluate the clinical efficacy of intramedullary nail fixation in atypical femoral fractures and explore the management approach.

From January 2010 to December 2014, a total of 116 patients over 60 years old with femoral intertrochanteric fractures or femoral shaft fractures were treated in Department of Orthopaedics and Traumatology. Among the patients, 11 with atypical femoral fractures, aged from 62 to 82 ( 69.3±5.6) years old, received surgical treatments. There were 2 males (18.2%) and 9 females (81.8%). 5 patients (45.5%) had the prodromal symptom of thigh pain. 9 patients (81.8%) had the history of long-term use of bisphosphonates with the duration of 3 to 9 (5.3±2.1) years. All the fractures received close reduction and antegrade intramedullary nail fixation. The Thoresen score and EuroQol 5 dimensions scores (EQ-5D) were applied to evaluate the extremity function and life quality after surgery.

All the operations were performed successfully. At least 1 years follow-up was accomplished with the follow-up period of 1 to 4 (1.8±0.9) years. There were 8 (72.7%) excellent, 2 (18.2%) good, 1 (9.1%) fair according to the Thoresen score with total excellent to good rate up to 90.9% at the last follow-up. The EQ-5D scores showed the life quality was similar with that before injury (P>0.05). Fracture healing was achieved in all 11 cases with time from 3 to 8 (5.7±1.6) month. There was no case complicated with infection, nonunion or implant failure during the follow-up period. No contralateral atypical femoral fracture was observed.

Atypical femoral fractures are uncommon in the clinical practice. Accurate diagnosis and appropriate management approach are the keys of satisfactory outcomes.

To develop a predicting model for evaluating the probability of malignancy or benign in patients with solid solitary pulmonary nodules through analyzing the clinical, radiologic, laboratory examination and radionuclide ¹⁸F-Fluorodeoxyglucose examinations data.

The data of the 203 patients(110 males and 93 females) with solid SPN who underwent surgical resection with definite postoperative pathological diagnosis from January 2012 to December 2014 in Shanghai Chest Hospital (group A)were retrospectively analyzed. The clinical data included age, gender, history of smoking, history of tumor; radiologic data included diameter in lung window, location, shape, clear border, lobulation, spiculation, vascular convergence, tumor cycle blood vessel, density, calcification, pleura indentation; laboratory examination included five serum tumor markers consisting of CA125, CEA, CYFRAL21-1, NSE, SCC. ¹⁸F-Fluorodeoxyglucose examinations included ¹⁸F-FDG PET-CT or SPECT. The independent predictors of malignancy were estimated through univariate and multivariate analysis, then the predicting model was built. Another 110 patients with solid SPN(group B)from January 2015 to December 2015 with definite pathological diagnosis were used to validate the predictive value of the model.

There were 159(78.3%) cases of malignancy and 44(21.7%) cases of benign in group A. Logistic regression analysis showed age, clear border, spiculation, calcification and ¹⁸F-FDG examination were independent predictors of malignancy in patients with solid SPN(P<0.05). A predicting nomogram was built according to the result of the multivariate logistic regression analysis. The area under the ROC curve was 0.890±0.038 for group B. The cut off value was 0.708. The sensitivity in group B was 86%, specificity 80%, accuracy 84.5%.

Age of patients, clear border, spiculation, calcification and ¹⁸F-FDG examination were independent predictors of malignancy in patients with solid SPN. The model showed good diagnosis efficiency in external validation, and could be applied to make decision for patients with solid SPN.

To investigate the clinical value of lung ultrasound in the late goal -directed fluid removal in critically ill patients underwent fluid resuscitation.

A prospective study was conducted. Forty patients underwent fluid resuscitation were enrolled in the Department of Surgical Intensive Care Unit of The First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to June 2015. Lung and heart ultrasound were conducted for lung B-lines and left ventricular ejection fraction (EF). Serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), central venous pressure (CVP) and serum creatinine were also measured and fluid balance was recorded in all patients enrolled.

Among the 40 patients enrolled, 35 patients survived and 5 died. In patients survived, B-lines reached its peak at 12(30)h after admitted to ICU. It started to decrease instantly after the peak and reached zero at (39±34) h. A higher peak was followed with more fluids to be removed later and longer ICU stay (P<0.01). Moreover, when compared with the survivors, B-lines in death reached a higher peak[7(8) vs 3(4),P<0.01]and without the tendency to drop down. EF was lower in death than in survivor (44.5%±3.5% vs 69.2%±11.0%,P<0.05). A lower EF was found to be followed with a higher peak of B-lines. The peak time of NT-proBNP and clinical dehydration treatment were later than the peak time of B-lines in survivors.

Fluid overloading occurs in late stage after resuscitation in critically ill patients. Lung ultrasound B-lines, which is more sensitive than the NT-proBNP and CVP, could help to monitor the patient's fluid status and guide the late goal-directed fluid removal.

To investigate the hodotopical organization of neural pathway of Chinese in posterior inferior frontal gyrus. Forprovide the basis for the individual protectionoflanguage functionin the operation of the language functional area.

Twenty volunteers underwentlanguage mapping using repetitive navigated transcranial magnetic stimulation(nTMS)to identify the essential language sites in posterior inferior frontal gyrus.Then, DTI tractography was used to reconstruct language-relevant fiber tracts within posterior inferior frontal lobe. Finally, the relationships between essential language sites and language-relevant fiber tracts were analyzed.

(1)Eighteen subjects hadlanguage sites which induce repeatable language errors in posterior inferior frontal gyrus. The total number of essential language sites was 39.46% of essential language sites located in ventral precentralgyrus, 41% in parsopercularis and 13% in parstriangularis. (2)Long segment of arcuate fasciculus had the probability of 100%to project into ventral precentralgyrus. Anterior segment of arcuate fasciculus had the probability of 100%to project into ventral precentralgyrus. Inferior frontal occipital fasciculus had the probability of 94% to project into parstriangularis. Uncinate fasciculus had the probability of 67% to project into parstriangularis. Aslantfiber had the probability of 100% to project into parsopercularis.(3)When the essential language site located in ventral precentralgyrus, it had the probability of 82% to correlate with long segment of arcuate fasciculus. When the essential language site located in parsopercularis, it had the probability of 79%to correlate with aslant fiber. When the essential language site located in parstriangularis, it had the probability of 60% to correlate with inferior frontal occipital fasciculus.

Essential language sites within distinct locations were conducted through different fasciculus, which enlightensour neurosurgeons thatin order to achieve both maximal lesions resection and language function protection, we shouldprotectboththe essential language cortices and language relevant subcortical connection according to each individual's hodotopical organization.

The aim is to explore the clinical characteristics of spinal cord glioblastoma and the therapeutic effect of microsurgery.

The clinical data of 18 patients with spinal cord glioblastoma from January 2011 to December 2014 in Beijing Tiantan Hospital were retrospectively analyzed including the clinical characteristics, the microsurgery treatment and the postoperative radiochemotherapy.

There were 12 cases for subtotal resection, 4 cases for partial resection and 2 cases for biopsy of the intraspinal tumors under microscope. The nervous system symptoms were improved in 11 cases, no changes in 5, deterioration in 2 and no deaths within 3 months after the operation. Among those, 5 cases (100%) with preoperative McCormick grade Ⅰ, 4 (57%) with grade Ⅱ, 2 (50%) with grade Ⅲ, and 0 with grade Ⅳ had improved. There were McCormick gradeⅠ8 cases, grade Ⅱ 5 cases, grade Ⅲ 2 cases andgrade Ⅳ 3 cases within 3 months after the operation. Seventeen patients were followed up from 6 to 36 months, and 1 patients was lost to follow-up. Five patients returned to normal work and study, while 8 died. The median survival time was 16 months.

Spinal cord glioblastoma is highly malignant with low incidence and poor prognosis, which should be performed by early operative treatment and postoperative adjuvant radiochemotherapy.

To assess the feasibility of susceptibility weighted imaging (SWI) in staging hepatic fibrosis(HF).

Sixty healthy rabbits were divided into three groups: HF group(n=32), control group(n=16), supplementary group(n=12). Rabbits in HF group and supplementary group were injected subcutaneously with 50% CCl₄ oil solution to establish hepatic fibrosis model. On the basis of preliminary test, eight rabbits from HF group and four rabbits from control group underwent liver conventional MR scans and SWI once a time at 4, 5, 6, 10 weeks after CCl₄ administration.After MR scans at each time point, rabbits were killed to detect pathological staging with Scheuer staging.The liver signal intensity (SI) and liver-to-muscle SI ratios (SIR) were measured. According to the Scheuer classification of histological fibrosis stages, the correlation about the SI value, SIR value and the histological fibrosis stages was investigated by using the Spearman correlation test. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of SWI for staging HF on the basis of the histopathologic analysis of HF.

There were fifteen rabbits in pathological staging F0, the value of SIR and SI was 0.974 ± 0.018, 374±44, SIR values of pathological staging from F1 to F4 were 0.963 ± 0.018, 0.796 ± 0.023, 0.786 ± 0.025, 0.512±0.024 respectively. SI values of pathological staging from F1 to F4 were 372±18, 376±22, 346±15, 288±19 respectively. In the early period of liver fibrosis, there were no statistical differences in the SI value between F0 and F1, F1 and F2 stage.With progression of hepatic fibrosis, from F2 to F4, SI value decreased, the difference was statistically significant (P<0.05). With the progress of liver fibrosis, SIR value was reduced. It was negatively correlated with the HF stages and SIR value(r=-0.896, P<0.05). ROC curve analysis showed that the efficiency of SI value diagnosis in liver fibrosis was high in the late stage of liver fibrosis, but it was low in the early stage.The performance of liver-to-muscle SI ratio on SWI was high in the early stage. Liver-to-muscle SI ratio had a higher diagnostic performance than SI in the diagnosis of liver fibrosis stages.

SWI can be a safe, reliable method for staging hepatic fibrosis and provide quantitative imaging basis for clinical treatment.

To investigate the safety and efficacy of dual antithrombotic regimen of warfarin and clopidogrel in patients who underwent coronary stenting and were with chronic oral anticoagulation.

Two investigators independently searched Pubmed, Embase and Cochrane for all reported studies, and yielding 6 articles, published before April 2015, enrolling 4 825 patients, follow-up for at least 12 months. Two investigators independently recorded the data regarding interventions and the occurrence of major bleeding, ischemic stroke, myocardial infarction and death. RevMan5.3 was used to do analysis.

Patients on dual antithrombotic regimen had insignificant reduction in major bleeding (odds ratio[OR]was 0.73, 95% confidence interval[CI]was from 0.46 to 1.14, and P=0.16) as compared with triple therapy. While the risk of ischemic stroke (OR= 0.78, 95%CI:0.44-1.38, P=0.39), myocardial infarction (OR= 1.19, 95%CI:0.92-1.53, P=0.18) and the overall incidence of death (OR=0.95, 95%CI:0.56-1.60, P=0.84) were also comparable between the two regimens.

Dual antithrombotic regimen of warfarin and clopidogrel is comparable to the recommended triple therapy in respect to the prevention of thromboembolic outcomes of MI/ death and ischemic stroke, while the risk of bleeding is similar in those patients with indications for chronic oral anticoagulation undergoing percutaneous coronary intervention with stent implantation.

To study the effects of subchorionic hematoma (SCH) on pregnancy outcome.

We searched publications from January 2000 to July 2015 for cohort and case-control studies evaluating subchorionic hematoma and perinatal outcomes, including spontaneous abortion, premature delivery and delivery mode.

Data of 6 articles analyzed by meta-analysis showed that SCH group had higher rate of spontaneous abortion, while no difference in premature delivery and delivery mode, compared with threatened abortion group.

Subchorionic hematoma increases the risk of spontaneous abortion, while premature delivery rate and delivery mode are not affected if the pregnant women can continue the pregnancy.

Thrombotic thrombocytopenic purpura (TTP) with abrupt onset, critical condition, poor prognosis and 90% mortality^[1]。 TTP is relatively rare, and it is more common in women of childbearing age. Pregnancy complicated with TTP accounts for 10% to 36% of the total incidence of TTP^[2]We now report a case of pregnancy complicated with TTP that we treated in May 2015 as follows.

With the development of society and the change of people's lifestyle, the number of diabetic patients worldwide is increasing year by year. The latest statistics of the World Health Organization show that there are about 347 million diabetic patients worldwide^[1]。 The prevalence of diabetes in China is even more severe. According to a 2010 survey by the National Center for Disease Control and the Endocrinology Society of Chinese Medical Association, the overall incidence of diabetes in adults over 18 years old in China reached 11.6%, and more than 20.4% of the elderly suffered from diabetes, of which more than 90.0% were type 2 diabetes^[2,3,4]This article mainly reviews the related research progress of type 2 diabetes.

At present, the treatment of osteoarthritis (OA) is still lacking the exact and effective treatment that can control the progression of the disease, and most of them are symptomatic treatment. Total joint replacement is needed to replace the original joint function in the late stage of the disease^[1,2]。 Studies have shown that many factors are involved in the occurrence and development of OA. Among them, the role of long chain non-coding RNA (lncRNA) in the regulation of gene expression has been paid more and more attention. The expression process of many important protein molecules closely related to the disease in the pathogenesis of OA is regulated by lncRNA, such as metalloproteinase (MMP), proteoglycanase (ADAMTS), insulin-like growth factor (IGF) -2, vascular endothelial growth factor (VEGF), etc. The study of the transcriptional regulation of lncRNA provides a new way of thinking for the treatment of OA. Therefore, the six lncRNAs closely related to them in the pathogenesis of OA and their roles and mechanisms are reviewed as follows.